MEDICARE: JOSEPH E. SWITRAS, PH.D., PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	LP2765	MN

General Provider Information

NPI Number	:	1447503115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH E. SWITRAS, PH.D., PA

Provider Business Mailing Address
First Line	:	208 W 2ND ST
Second Line	:	SUITE 116
City	:	FAIRMONT
State	:	MN
Zip	:	56031-1843
Country	:	US
Telephone Number	:	507-235-5651
Fax Number	:	507-235-5651

Provider Business Practice Location Address
First Line	:	208 W 2ND ST
Second Line	:	SUITE 116
City	:	FAIRMONT
State	:	MN
Zip	:	56031-1843
Country	:	US
Telephone Number	:	507-235-5651
Fax Number	:	507-235-5651

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	JOSEPH ELLSWORTH SWITRAS
Credential	:	PH.D., LP
Telephone Number	:	507-235-5651

Provider Enumeration Date	:	10/18/2012
Last Update Date	:	10/18/2012

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